Health data doesn't support testosterone for men

Men over the age of 50 are being continually targeted with advertisements for testosterone replacement gels and patches. However, research is now questioning the real risks and benefits associated with getting tested and treated for low testosterone levels.

Testosterone supplementation is touted to improve cardiovascular health, sexual function, physical function and mood in men who have low levels of testosterone. However, a review of more than 200 clinical trials questions those claims. Dr. Adriane Fugh-Berman, who is with Georgetown University Medical Center, Washington DC, said testosterone is marketed to treat a number of conditions but the data show there are no clinical trials to support such claims.

Dr. Fugh-Berman and colleagues conducted a review of 226 randomized controlled trials between 1950 and 2016 in which testosterone was compared to placebo for cardiovascular health, sexual function, physical function, mood or cognitive function. They found that testosterone supplementation did not show consistent benefit for cardiovascular risk or sexual function. The same was true for mood and behavior or cognition.

Emerging data

The researchers found there were improvements in some surrogate markers of cardiovascular risk. However, there was little evidence for improving health. Testosterone was ineffective in treating erectile dysfunction (ED) and did not show a consistent effect on libido. Testosterone supplementation consistently increased muscle strength but did not have beneficial effects on physical function.

Dr. Fugh-Berman said testosterone gels and patches are marketed for non-specific symptoms associated with normal aging. However, testosterone is not a reasonable treatment for aging. Some prostate cancers are fueled by testosterone and this has always been a concern.

“Emerging data does not show an increased risk of prostate cancer, unless the patient has untreated high grade prostate cancer,” said Dr. Jason Hedges, who is an assistant professor of urology in the OHSU School of Medicine, in Portland, Oregon. “Decisions should be made with the provider and the patient.”

He said it is reasonable for a man over 50 to get screened for low testosterone. However, he cautioned that there can be significant pitfalls.

“Many other medical issues, life stress, and medications can mirror these symptoms. A man needs to have a discussion with a qualified provider. There are too many “men’s health clinics” that will treat inappropriately,” Dr. Hedges told Senior Voice.